Have you ever wondered if payers are helping primary care by offering complementary access to care through 24/7 telemedicine physicians, payer-owned and operated health centers, or drug store clinics? Or are these efforts undermining the primary-care physician/patient relationship that is the supposed key to patient engagement (and thus bending the healthcare cost curve)? And more importantly, does the answer matter?

Several months ago, I got an e-mail from my health insurance company. The e-mail suggested I use their telemedicine service and espoused the following benefits:

• Costs the same or less than a primary-care visit;

• No sitting in germ-filled waiting rooms (ouch); and

• A doctor who will give my health the time and attention it deserves (double ouch).

I presumed payers offered after-hours hotlines to prevent ER visits. This e-mail removed the veil from my naïveté. While primary care and payers share the goal of keeping patients out of emergency rooms, it is the payers who benefit most. Keep in mind, this debate is not about quality of care and it certainly isn't about continuity of care. It's about money.

Here's what I suggest primary-care physicians do to address this competition:

1. Accept that these alternatives are not going away.

Especially since current primary-care shortages are being forecasted in many areas. Complain and protest as we might, it's a Don Quixotic fight that distracts from the core strategy of out-servicing our new competition.

2. Understand that convenience trumps great care.

We live in a convenience-driven society where consumers (aka patients) prioritize accessibility over quality; sorry to burst your bubble. Think about take-out Chinese food. If you can pick up decent food on the way home rather than driving an extra 10 minutes for great food, which one do you pick? To retain and attract patients, think like a consumer.

3. Take a hard and candid look in the mirror.

Are you patient-friendly in your hours, location, and care? How can you be better? If you deliver great service and great access, your patients have little reason to seek out other options. Don't give them an excuse to look elsewhere.

4. Get proactive.

A payer is paying another doctor (possibly in another state and time zone) to care for your patients via telemedicine (while you are taking evening/weekend call and getting paid nothing). Why not approach the payer and ask to provide your own telemedicine coverage at the same price? This is one time the continuity-of-care argument actually may be compelling.

5. If you can't beat 'em — work with them.

If you choose not to offer extended or weekend hours, forge a relationship with your favorite urgent-care center and make sure your patients know about it. Make sure the urgent-care center sends you notes on your patients; that's your ROI for this relationship, along with increasing odds that your patients won't wander to another provider.

6. If you can't work with 'em — beat them.

Drug store clinics are about convenience, period, and perhaps easier access to antibiotics. Have you thought about setting up your own vital-signs or minor-care kiosk at the grocery store or mall? Could you link it to your patient portal and capture patient data trends? A kiosk could be a wonderful patient attraction/retention tool.

7. Read "Zombie Loyalists."

Finally, I urge each of you to read or listen to Peter Shankman's new book "Zombie Loyalists." His message — that vocally loyal patients are the most effective marketing tool — is one most of us get, but few of us embrace. It's a great read and he offers solid advice for creating your own loyal patient base in both the old-fashioned (word of mouth) and new-fashioned (social media) worlds.

Payers think like most companies: A dollar saved is another dollar to the bottom line. Find ways to strengthen your position as an alternative to remote or retail care options, and your patients will remain your patients. No one says it will be easy, but that's your best chance at facing and defeating the competition; whether it's a traditional competitor, a drug store, or even a payer.

Lucien W. Roberts, III, MHA, FACMPE, is administrator of Gastrointestinal Specialists, Inc., a 22-provider practice in Central Virginia. For the past twenty years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He may be reached at muletick@gmail.com.

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